These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). Unauthorized use of these marks is strictly prohibited. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. You may also begin strengthening exercises if needed. and transmitted securely. Van Dommelen BA, Zvirbulis RA. Would you like email updates of new search results? 2009;6:e1000097. Your thumb will be immobilized in a splint and should not be moved until follow up. All but 2 were level IV evidence. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. J Hand Surg Glob Online. Epub 2014 Oct 22. Thumb sidedness reported in 3 studies (51 thumbs). Background: Unilateral injuries: 291 and bilateral injury: 1. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). The https:// ensures that you are connecting to the Bailie DS, Benson LS, Marymont JV. **Stener lesion status reported in 6 studies (145 thumbs). Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis. I was able to work while wearing the splint. #Injury location reported only in 3 studies. Please try again soon. Despite a perception that UCLR has minimal morbidity, a review of all published literature revealed that 12.0% of UCLR surgeries result in postoperative ulnar nerve complications. A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 45. There is, however, agreement on the treatment goals for repair or reconstruction of the UCL, which are to obtain and maintain an anatomic reduction of the MP joint, reproduce the anatomic origin and the insertion of native ligament, ensure sufficient strength to allow early range of motion, and minimize donor site morbidity if autograft is used. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. Bean CH, Tencer AF, Trumble TE. 8. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. 27. A score of 2 was assigned if the item was completely and accurately performed and reported. 1998;23:503506. 1995;23:222226. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. 1961;43-A:541546. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. This ligament prevents the thumb from pointing too far away from the hand. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 39. J Hand Surg Br. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Study design: 15. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Meta-analysis of the pooled data was completed. Search performed on November 17, 2011. Wolters Kluwer Health There were no cases of intraoperative ulnar nerve injury reported. Sixty nine (86.3%) patients had grade 3 tears. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. Eventually this abnormal movement will wear out the joint and it will become arthritic. Hand Clin. Gamekeepers thumb: a prospective study of functional bracing. The torn thumb ligament is repaired or reconstructed during surgery. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. The grip strength and the pinch strength were 94.3% and 92.27%,. 2005;24:217221. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. Epub 2014 Dec 30. Posner MA, Retaillaud JL. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Chir Main. eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. three muscles provide deforming forces at the base of the thumb. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Stretching or even a rupture of the graft is also possible. A UCL consists of three bands or divisions: the anterior (front), posterior (back) and transverse (across) bands. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. 1962;124:396411. 1995;18:11611165. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Arnold DM, Cooney WP, Wood MB. Sports Med Arthrosc Rev. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. Figure 46-2 Approach to the ulnar collateral ligament. Tension wire fixation of avulsion fractures in the hand. There were 200 acute injuries and 93 chronic injuries. [23,3638] Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. If your bone is broken, a pin will be used to put it in place. 1989;14:567573. Acta Chir Scand. Bennet Fracture. This injury is sometimes called "skier's thumb" because skiers are prone to this injury when they fall with their hand strapped . 34. 2003;8:8185. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Oka Y, Harayama H, Ikeda M. Reconstructive procedure to repair chronic injuries to the collateral ligament of metacarpophalangeal joints of the hand. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. Stener B. Skeletal injuries associated with rupture of the. 2000;16:345357. Rupture of the. 38. Ulnar Collateral Ligament Repair . 24. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Proximal interphalangeal joint injuries of the hand. Your surgeon will discuss these options with you. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Fourteen articles were included and analyzed (293 thumbs). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Selection bias was presented based on the variance in subject age, gender, hand dominance, injury chronicity, injury location, the presence or absence of bony avulsion, the presence or absence of Stener lesion, and the retrospective nature of most of the studies. eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. may email you for journal alerts and information, but is committed Only 1 study reported significant loss of either MP and interphalangeal joint motion (P < 0.005).25 Except for 2 patients with significant postoperative weakness, full or near-full strength (key pinch and grip) was restored in all studies. Acute gamekeeper's thumb. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. It essentially forms a soft-tissue sling that keeps the radial head in place on the humerus. You will receive email when new content is published. The limitations of this systematic review are reliant on the studies analyzed. Clipboard, Search History, and several other advanced features are temporarily unavailable. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. There were 6 studies that reported clinical outcomes after acute UCL repair using different techniques.20,2426,28,29 Repair techniques (Table 4) included pullout suture over button with or without Kirschner wire immobilization, suture anchors, soft tissue periosteal suture, and arthroscopic Stener reduction with K-wire. Click the topic below to receive emails when new articles are available. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. Bethesda, MD 20894, Web Policies There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. 1,5,9,10 In acute cases of complete tears involving high-level . Furthermore, each bibliography was cross-referenced for potentially inclusive studies missed by the original search terms. 22. Nonoperative treatment often failed, necessitating surgery. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament.
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